Recently, I was honored to be included in Mother Earth Living magazine’s piece on foods that “fight illness” (or better yet, prevent them). I was one of several integrative practitioners, including Andrew Weil, Tieraona Low Dog, and Aviva Romm, who contributed recipes for yummy and healthful dishes. My “Sautéed Wild Medicinal Mushrooms” recipe – perfect for a cold winter evening – can be found here. Bon appetit!

DEHP (di-(2-ethylhexyl)phthalate) is a compound commonly found in plastic medical devices made from polyvinyl chloride (PVC). This chemical has come under increased scrutiny with respect to the care of our most vulnerable children: critically ill newborns hospitalized in neonatal intensive care units (NICU’s). The incredibly sophisticated level of care found in the NICU saves the lives of thousands of premature babies every year, but it seems that the very equipment used to aid these infants may in fact be causing serious harm. The FDA lists the following products commonly used in NICUs as containing DEHP:

- IV bags and tubing

- Umbilical artery catheters

- Blood bags and tubing

- Nasogastric feeding tubes

- Respiratory tubing

- Enteral nutrition feeding bags

Concerned by the widespread exposure of sick newborns to these devices, researchers at Johns Hopkins Bloomberg School of Public Health – asreported by NPR – “determined that a critically ill preemie hooked up to multiple tubes and devices containing DEHP could be exposed to 16 milligrams per kilogram of body weight a day of the chemical, which is 160,000 times higher than desired to avoid liver damage.” Why would this be a concern? For one, DEHP has been linked, per report by the U.S. Environmental Protection Agency (EPA), to endocrine disruption, birth defects, asthma and cancer in animal studies. Additionally, Dr. Eric Mallow, the lead researcher on the Hopkins report, notes, “DEHP and other phthalates are proinflammatory, and most of the injuries that preemies get are inflammatory in nature.” A recent review of the adverse effects of DEHP and related phthalates on children’s health found that “fetal and childhood exposure to some phthalates may perturb normal development, with several studies consistently reporting increased risk of allergic diseases” and offered that “providers can counsel concerned patients to reduce phthalate exposures in order to protect the developing fetus and child from potential adverse health outcomes.”

In this spirit, some hospitals have tried to eliminate or reduce the use of phthalate-containing products. However despite best intentions, hospitals have been unable to replace DEHP in all areas including the NICU. Why? Because there is a shortage of vendors able to supply alternative, theoretically safer products. “Consistent supply is essential to getting hospitals to switch to DEHP-free products. Additionally, as more healthcare facilities create demand, the more manufacturers will respond,” comments Kyle Tafuri, Sustainability Advisor at Hackensack University Medical Center in New Jersey. Erin S. Ihde, MA, CCRP, researcher at the The Deirdre Imus Environmental Health Center at HackensackUMC, advises, “One of the keys to the success of DEHP-free medical products is having clinicians and administrators advocating for the change within their departments. It only takes one person to educate others and move the process forward.”

Does the benefit of current medical therapy in NICU’s outweigh the harm? While one would not advise abandoning the use of feeding tubes, IV’s, blood products and breathing tubes given their life-saving contributions, we should be concerned about the ongoing exposure of premature, critically ill babies to potentially toxic plasticizers.The theoretical, animal and preliminary human evidence linking DEHP and its metabolites to the disruption of hormonal and immunological pathways is deeply troubling.

Sadly, studies to evaluate the immediate and long-term impact of DEHP on babies’ endocrine, immune and neurological systems are lacking. Under the precautionary principle guidelines, many environmental health scientists advocate for avoiding the use of any potential toxic chemicals until we can adequately insure human harm will not result from exposure. Yet, this is not the current regulatory environment in the United States. Too often, chemicals are introduced into mainstream use, even in the healthcare industry, without adequate proof of safety. As we’ve previously noted, children in particular are quite vulnerable and are frequent victims of environmental injustice. For the preservation of our children’s health, and our future, we must work together to adopt new integrative strategies to address the complex environmental challenges we now face.

This month marks the public television premiere of a very important film, Race to Nowhere. Vicki Abeles’ provocative documentary tells the story of children, parents and teachers who are increasingly frustrated by an educational system pushing our kids to breaking point. As a pediatrician and a parent, I am heartbroken by the growing number of kids I see with anxiety, depression and mind-body ailments like ulcers and migraines associated with the stress of just trying to keep up. Shockingly, some of these children are in elementary school.

Growing up, I don’t remember my friends and classmates having food allergies. In fact, there was one kid in my entire elementary school with a peanut allergy — it was so unusual we all knew who he was.

Today? The prevalence of food allergies has skyrocketed, and it’s estimated that 8% of children and adolescents 18 and under have been diagnosed. Amazingly, 30% of these kids have multiple allergies. Equally concerning is that the severity of reactions has worsened over time.

What’s going on and what can you do about it? Here are answers to five questions many people have about food allergies.

Bumps, burns, bruises and bites: a typical summer day in the life of anyone with kids. The good news? These and other common summer ailments typically respond to safe and easy-to-use natural remedies. Some parents are skeptical that natural cures don’t work as well as conventional OTC treatments – you know, the ones loaded with chemicals you can’t pronounce but sure sound like serious medicines. My advice? Skip the chemicals – and the side-effects – and check out my top nine natural summertime cures.

(Disclaimer: If you’re concerned an illness or injury may be serious enough to warrant immediate medical attention or is worsening with any home treatment, call your doctor.)

Bites: For pesky insect bites, go to your kitchen cabinet before your medicine cabinet. Baking soda has alkaline properties that help neutralize insect bites. You can apply topically as a paste by mixing the baking soda with a small amount of water. Apply as needed until the pain and itching subside.

Bumps and Bruises: My go-to option for bumps before they become bruises is Arnica montana (aka “wound herb”), derived from the daisy family. Arnica can be applied topically in ointment form or can be taken orally in homeopathic form (under the tongue). I generally recommend the 30c dilution for acute oral use. A typical regimen is 5 pellets given every 15 minutes for the first hour, then hourly for four hours and then every 2-4 hours for the remainder of the first 24 hours (while awake). I then recommend taking 5 pellets three times a day for several days until any soreness or bruising has resolved. For children who cannot or will not put the tablets under their tongue, you can dissolve the pellets in water and let them sip gradually over a few hours. Topical arnica can be used separately or in addition.

Stings: “Like cures like” according to one of the core principles of homeopathic medicine. Therefore, for bee stings, I recommend homeopathic Apis mellifica, derived from the honeybee. For acute use, again, the 30c strength is optimal, and this is definitely one remedy you want to start ASAP to limit the pain, redness and swelling from the sting. You can follow the same general dosing guidelines used for Arnica cited above.

Sunburns: If you have one plant in your house, it should be Aloe vera. The medical use of the Aloe plant can be traced back over 6,000 years to early Egypt based on evidence from ancient stone carvings. The sticky gel found inside the spiky leaves contains numerous natural chemicals that block pain, itching, inflammation and infection, while increasing circulation to speed healing. Of course, you can buy Aloe vera gel if you don’t have a plant handy, and you should apply the gel to the sunburn as often as needed to soothe the inflamed skin.

Scrapes: My first-line option for minor skin irritations is topical Calendula officinalis, derived from the marigold. Calendula possesses potent wound healing capabilities. Apply topically as needed, usually three times a day. Calendula comes in ointment, cream and gel formulations, and it’s so safe that it’s included in many baby diaper rash products.

Impetigo: Cuts and scrapes “gone bad” can lead to weepy, crusty skin infections known as “impetigo.” Caused by staph or strep skin bacteria, impetigo does not necessarily need antibiotic treatment. The best natural solution? Honey. Not by mouth, but directly on the skin. Yes, you read that right. In fact, one special type of honey – Manuka, from New Zealand – has incredible natural antibacterial properties. Apply a small amount to the infected area three times a day and prepare to be amazed.

Swimmer’s Ear: Some kids swim so much each summer you’d swear they’ll grow gills. Not likely, but some actually do get horrible ear aches known as “swimmer’s ear” or otitis externa, an infection and inflammation of the ear canal. Typical conventional prescriptions include topical antibiotic and steroid drops, but there are two safer alternatives you can try first. Apple Cider Vinegar (ACV) contains acetic acid, proven effective in treating the pain and swelling from swimmer’s ear. Place a few drops of ACV into the affected ear three or four times a day for relief. Another DIY option is garlic oil eardrops. Crush a clove of garlic in a tablespoon of olive oil, stir well, and warm slightly on the stove. Mix well and strain out the garlic pieces. Be careful to not make it hot – even room temperature is fine. Instill a few drops of the garlic infused olive oil into the affected ear three times a day until the pain has gone. Both the garlic and olive oil have natural anti-inflammatory and anti-bacterial properties.

Dehydration: With summer comes heat. Some kids are better than others about staying hydrated, but even the most diligent can suffer from heat exhaustion on particularly steamy days. Looking for a good alternative to artificially colored and sweetened sports drinks? Consider coconut water, perhaps nature’s best rehydration solution. Rich in natural electrolytes, coconut water is now readily available and provides a more holistic option to stay hydrated on those hot summer days. Taste an issue? Flavor with a small amount of herbal tea like mint or lemon.

Motion Sickness: Summer road trip on the agenda this year? Long rides in cars or on boats, planes or trains can be tricky business when traveling with motion-sickness prone youngsters. Next time you’re faced with this dilemma, consider giving your child some ginger. All forms of this natural anti-nausea gem can be helpful, including chewables, capsules or teas. Give a small amount just before you go and regularly throughout the journey as needed. An additional remedy I find really effective are “sea bands,” those wrist bands that come with little buttons on the inside. Place the bands on both wrists so that the button lies on the P6 pressure point (an acupressure trigger point located three finger breadths below the main crease below the palm of the hand, right between the two stringy tendons you’ll feel there). Your child can massage the points gently over the bands for added pressure (and distraction) if need be. Happy traveling!

As a pediatrician, I am incredibly lucky to work with children, day in and day out. It’s impossible not to be captured by their amazement with the mundane and their joy in the smallest moments. I’m often reminded of Winslow Homer’s 1872 painting, “Snap the Whip,” depicting boys playing with abandon in a field outside their rural schoolhouse. So eloquently portrayed is the simplicity of another time, kids out in the natural world for no other purpose than to play, freely and without a care in the world.

Contrast this with contemporary schoolyards with their meticulously designed jungle gyms and artificial surfacing, often empty throughout the day as more and more schools abolish recess or replace free play with highly structured, adult-supervised activities. I’ve realized, as I see increasingly anxious and depressed children come to my office looking for guidance, that the answers often lie not in my prescription pad but outside my window.

A 17 year old so stressed by college applications and SATs that she isn’t eating and has lost ten pounds this month. A 15 year old increasingly distracted and irritable because he is falling further and further behind in math and gets home at 10pm each night after soccer practice. A 13 year old consumed by the social pressures in 8th grade and what her friends are posting online keeping her tossing and turning until 1 AM. Sadly, these are only some of the kids I’ve seen in my practice this month deeply affected by feelings of overwhelming stress in their lives. As a doctor and as a parent, I want nothing more than to reduce the pressure they are experiencing. Yet I have come to realize that the most helpful thing I can teach them is not avoidance but ways to better cope with stress.

There are many potentially effective practices to build stress-coping competency. The Center for Contemplative Mind in Society has developed a wonderful graphic depicting a Tree of Contemplative Practices to consider, ranging from more active and creative to more restive and reflective. The best of these actively engage teens and can become life-long self-care skills. At the Whole Child Center, we’ve found an integrative approach combining lifestyle counseling (including discussion about nutrition, fitness and sleep/rest) with mind-body skill coaching (typically yoga and meditation) to be ideal. Research is beginning to support our observations. One recent study found that, compared to a control group of “PE-as-usual” students, teens participating in a yoga program of physical postures, breathing exercises, relaxation, and meditation 2 to 3 times a week for 10 weeks reported improved mood and reduced anxiety. With rising numbers of adolescents being prescribed psychoactive medications and reporting significant adverse effects and questionable efficacy, it is crucial we continue to examine holistic programs that create optimal health in mind, body and spirit. Yes, these innovative integrative solutions take time and financial resources to implement, but I would argue the they are quite cost-effective in comparison to the price we are paying for the deterioration of our children’s mental and physical health.

Yoga is so much more than your typical medical “intervention.” Still, as is the case with many health-associated modalities from diverse traditions (e.g., Ayurveda, Traditional Chinese Medicine), yoga is being increasingly integrated and evaluated as a tool to address specific physical and emotional concerns within our conventional healthcare system. Therapeutic yoga programs are now in place in hospitals and health centers across the world, and both practitioners and patients are reaping the benefits. Yogis and medical centers are navigating this dance of integration, both trying to maintain the integrity of their practices. Some wonder if one can prescribe yoga as mind-body medicine without diminishing the spiritual aspects. I would argue that it is precisely this mind-body-spirit holistic framework that modern medicine needs most at a time when so many patients are in need of healing rather than conventional one ill – one pill solutions.

One of the greatest challenges within contemporary health systems is bringing yoga to those in greatest need yet unable to afford or access it. Bridging the gap are an increasing number of nonprofit yoga service organizations like Kula for Karma, providing yoga in collaboration with hospitals at no cost to those most vulnerable. I am deeply honored to serve on Kula’s Board of Directors and witness the good that groups like this do. Examples of populations served include children and adults with cancer, children with autism and other special needs, caregivers, military veterans coping with post-traumatic stress disorder, victims of domestic violence, older adults with cognitive and medical impairments, and adolescents and adults in recovery from substance abuse and addiction. While it may seem apparent, it is important to do the research to support our intuitive senses that yoga can be of great value for all in need. To this end, I wanted to share with you a sampling of the growing evidence base for yoga as a therapeutic intervention. It is through a better understanding of who and how yoga helps heal that we may one day see it fully integrated into our health care system.

1. Adults with cancer: The greatest number of hospital-based yoga programs and yoga research citations are related to the well being of adults with cancer. One of the most recently published studies (Yoga’s Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial) examined both clinical and immunological outcomes in 200 breast cancer survivors. Researchers at the Ohio State University’s Stress and Health Lab found that women in the active treatment group (12 weeks of 90-minute twice weekly hatha yoga classes) reported significantly less fatigue and more vitality at the end of the 3-month program compared with those in the control group (on a wait-list). Also, of great interest, the group that participated in yoga classes has significantly lower immune system markers associated with inflammation. The authors conclude, “Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.”

2. Children with autism: With the rising number of children diagnosed with autism spectrum disorders, parents are constantly looking for evidence-based strategies to help with challenging behaviors at school and at home. Several innovative yoga programs have been developed specifically for autistic children, and one was the subject of a promising controlled study (Efficacy of the Get Ready to Learn yoga program among children with autism spectrum disorders: a pretest-posttest control group design) published in the American Journal of Occupational Therapy. 24 autistic elementary school students participated in a daily yoga program for 16 weeks and were compared to a control group of 22 students maintaining their usual morning routines. Researchers at the NYU Department of OT found that students in the GRTL yoga program showed significant decreases in teacher ratings of maladaptive behaviors compared with the control participants.

4. Military veterans with PTSD: The U.S. Department of Veterans Affairs estimates that up to 20% of Veterans of the Iraq and Afghanistan wars (Operations Iraqi and Enduring Freedom) suffer from post-traumatic stress disorder (PTSD). Yoga is one of the newer and more popular integrative therapies being studied to see how effective it can be for PTSD symptoms like anxiety, depression and sleep disruption. A recent feasibility study published by researchers from the Southeast Louisiana Veterans Heath Care System in New Orleans (A yoga program for the symptoms of post-traumatic stress disorder in veterans) followed 12 Veterans with military-related PTSD who participated in a twice-weekly yoga program for six weeks. Although not a randomized, controlled study, it did find significant improvements in hyperarousal symptoms and sleep quality. This promising pilot trial demonstrated that yoga is in fact a feasible and potentially effective adjunctive therapy for PTSD symptoms in military Veterans and should pave the way toward larger, controlled studies.

5. Victims of domestic violence: Yoga has been proposed as a potentially effective complementary therapy for victims of domestic violence who suffer from post traumatic stress disorder, anxiety and depression. While anecdotal reports suggest yoga can be helpful for these individuals, very little research has been published regarding this population. An interesting study (A preliminary investigation of the effects of giving testimony and learning yogic breathing techniques on battered women’s feelings of depression) from the Department of Psychology at Fayetteville State University in North Carolina examined the impact of yogic breathing techniques on feelings of depression in African American and European American abused women. Theoretically, researchers postulated that teaching these women how to calm their minds by focusing on yogic breathing might help them regain control over their bodies and their lives. In this study, yogic breathing was studied as an intervention alone and in combination with a technique known as “giving testimony” about experiences of intimate partner violence. Results indicated that learning yogic breathing techniques alone and combined with giving testimony significantly reduced feelings of depression for the women in this trial.

6. Older adults with cognitive impairments: Baby boomers are growing older and are at increasing risk for dementia and other cognitive impairments. While researchers are always looking for a magic pill to reverse these declines, perhaps yoga can provide not a safer and more effective route to do so. One controlled study (Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function) did evaluate the impact of yoga on cognitive function in residents of elderly homes in India. This randomized controlled study included an intervention yoga group of 44 seniors and a control waitlist group of 43 seniors who completed the study period of 6 months. Those in the intervention group received daily yoga sessions for one month, weekly until the third month and then encouraged to continue unsupervised until 6 months. Compared with the control group, the yoga group showed significant improvement in areas of memory, attention, executive function and processing speed. Though not yet studied, it may be that practicing yoga can in fact prevent cognitive impairments from developing or progressing.

7. Adults with substance abuse/addiction: A number of complementary therapies have been evaluated in the treatment of those with substance abuse/addiction, including acupuncture and yoga. One of the most recent trials (Yoga effects on mood and quality of life in Chinese women undergoing heroin detoxification: a randomized controlled trial) examined the effect of yoga on mood and quality of life in 75 Chinese women (aged 20-37 years) undergoing detoxification for heroin dependence. The women were randomized to a six month yoga intervention group or a routine hospital care control group. Measures of mood and quality of life were completed for both groups at study entry and following three and six months of treatment. Over this time period, the intervention group demonstrated a significant improvement in mood and quality of life compared with those in the control group.

(Note: An edited version of this post first appeared in MindBodyGreen)

Is it possible that something as simple as happiness could be the motivating factor to stimulate sustained ecological behavioral change? The developing field of ecopsychology has spurred an interest in research looking at how our connection to nature is tied to our well being.Along these lines, John Zelenski and Elizabeth Nisbet from Carleton University in Ottawa, Canada recently published a fascinating study, “Happiness and Feeling Connected: The Distinct Role of Nature Relatedness.”The authors found that we have unique relationship with nature that is a “significant distinct predictor of many happiness indicators, even after controlling for other connections” and conclude that “nature relatedness could be a path to human happiness and environmental sustainability.”

Springtime bring the glorious smell of flowers in bloom. It happens every year, without fail, yet I never cease to be amazed at the persistence of nature. I also know many of my patients suffer with seasonal allergies, so I’m mindful of preparing them early, before the itchy-sneezy season kicks in. While there are some effective natural treatments for allergy symptoms, I’ve found (like with many ailments) prevention trumps treatment. Conventional medicine, in my experience, does not offer much in the way of safe and effective seasonal allergy preventive strategies – but the natural world does. One remedy, in particular, would make Winnie-the-Pooh very happy.